1215127220 NPI number — SHARI L. KAMINSKY, DPM, PC

Table of content: (NPI 1215127220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215127220 NPI number — SHARI L. KAMINSKY, DPM, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARI L. KAMINSKY, DPM, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215127220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1224 GRAHAM RD STE 3010
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORISSANT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63031-8028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-355-0074
Provider Business Mailing Address Fax Number:
314-355-0337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1224 GRAHAM RD
Provider Second Line Business Practice Location Address:
SUITE 3010
Provider Business Practice Location Address City Name:
FLORISSANT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63031-8028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-355-0074
Provider Business Practice Location Address Fax Number:
314-355-0337
Provider Enumeration Date:
07/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BECKER
Authorized Official First Name:
JODI
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
314-355-0074

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 000648 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500122700 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480033460 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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